Every Week Counts Campaign Raises Awareness About Dangers of Early Induced Labor

With back pain, insomnia and fingers so swollen they can barely hold a fork for the rare meal that doesn't result in massive heartburn, in the final weeks of a pregnancy, many women are ready to get that baby out and now.

Over the past two decades, instances of induced labor have increased by more than 13 percent, a number that is, for the most part, attributed to a rise in elective, rather than medical, inductions. Although a pregnancy is labeled full-term between 37 and 42 weeks of gestation, studies show that scheduling cesarean sections and inducing labor for non-medical reasons before 39 weeks can prove dangerous to the child's health and development. The March of Dimes and the American Congress of Obstetricians and Gynecologists (ACOG) have connected with doctors and hospitals across the country in a movement to eliminate unnecessary early births.

"Some people think, hey, it's time, the baby should be fine," said Dr. Scott Berns, the senior vice president of the March of Dimes Chapter Programs.

But babies who are born prior to 39 weeks are more likely to be admitted to the intensive care unit, Berns continued. They are also at higher risk of breathing, feeding, weight, hearing and vision complications than babies born after 39 weeks of gestation.

Even though ACOG has readily disseminated this information since the 1970s, the number of early electively-inducted labor and C-sections has only increased. According to the March of Dimes, between 1990 and 2006, the rate of births between 36 and 38 weeks has risen exponentially (between 25 and 50 percent.) Births after 40 weeks of gestation have decreased drastically.

And so explains the reasoning behind the Every Week Counts campaign to educate patients and medical practitioners on the importance of waiting to deliver.

"If a baby needs to be born for a medical reason, that baby should be born," said Dr. George Macones, an OBGYN at Washington University's School of Medicine in St. Louis. "But when I was practicing in Philadelphia, patients put pressure to deliver early for what I call 'social purposes.' "

According to Macones, births of convenience are often requested to accommodate visiting relatives who want to witness the birth or a doctor's busy schedule.

"But there are also problems with dating," Macones said. "What you think might be 37 weeks can really be 36 or 35."

The developmental differences between a 35- and 39-week-old baby is drastic. A baby's brain at 35 weeks, for example, weighs only two-thirds of what it will weight at 39 to 40 weeks. Furthermore, preterm birth (before 37 weeks) costs the United States $26 billion annually, according to the Institute of Medicine.

The California Chapter of the March of Dimes created a downloadable toolkit that assists hospitals nationwide in eliminating non-medically indicated deliveries prior to 39 weeks of gestation.

Hospitals in what are known as the "big five" states (New York, California, Florida, Texas and Illinois), which account for 40 percent of births in the United States, have been specifically targeted for participation. But the initiative has had a much farther reach. The toolkit is downloaded roughly 30 times a week and has been used in at least 35 states.

Oklahoma, which ranks 46th in the nation for infant mortality, began the Every Week Counts program last week.

"We did have a state initiative recognizing that our state is one of the worst," said Barbara O'Brien, senior coordinator of the Oklahoma University Health Sciences Office of Perinatal Continuing Education. Sixty-eight percent of births in Oklahoma occurred before 40 weeks.

"We are almost at 100 percent participation," O'Brien said. Of 60 hospitals statewide, 55 are contributing to the program.

O'Brien said she was shocked to see how frequently cases of induced labor occurred due to elective rather than medical reasons.

There is a dearth of data as to how many scheduled deliveries prior to 39 weeks are elective, Berns said.

"The first thing a hospital will say when you ask the question, their first reaction is, 'Well we don't do that, we don't deliver babies unless they need to be delivered,' " Berns said. "When they actually pull the charts, though, what happens oftentimes is that they'll look and say, 'Gosh, we were at 20 percent.'"

With the Every Week Counts program gaining momentum, medical practitioners hope that education will be the key to a shift in mindset and behavior.